Purpose:Manipulating instruments inside the human body during laparoscopic surgery and NOTES translumenal surgery can be very difficult for even well experienced surgeons due to the loss of 3D depth perception. Classical navigation techniques are often incapable of providing support in such situations, as the augmentation of the scene with the necessary artificial markers is usually cumbersome and leads to increased invasiveness. To overcome this limitations, we developed the novel virtual image overlay navigation with flattery support system by wireless motion sensing technology using fluctuation adjusting accelerometer, that fuses together the actual and the virtual space.Methods:We subjected 20 laparoscopic surgeries and 10 NOTES procedures.From the volume data acquired with MDCT we generated the virtual laparoscopic navigation view by using volume rendering method in OsiriX application during surgery. Surgical navigation was superimposed on the body surface projected from above the operative field. A 3-D accelerometer was attached to the endoscopes for adjusting its image fluctuation to OsiriX navigation system. We evaluated the utility of this flattery support system Results and discussions:Volume rendering method by OsiriX could show virtual anatomies of the patients from skin level to the internal organs immediately. This situation provided the marker less registration by adjusting the physiological markers such as the navel, nipples, and the iliac bones. An operator raised surgical recognition as more intuitive navigation by wireless operation to link the change of actual field and support images. The augmented reality projection had within 10mm range error and improved hand-eye coordination. Motion sensing technology had the ability to sense both rotational orientation and translational acceleration along 3-D axes, providing six degrees of freedom, through the use of accelerometers. It could revise the visual navigation aid from preoperative imaging with a fine adjustment. Moreover it was useful for corporation the endoscopic video stream and registered on body surface when a 3D surface is intraoperatively reconstructed from volume rendering in OsiriX. There was also no complication within this study.

Conclusions:Image overlay navigation by fluctuation adjusting accelerometer can synchronize an endoscopic view and operative field with a fine adjustment by flattery support system. It improves space perception and misconception in laparoscopic surgery and NOTES.